For the study, researchers calculated nontraumatic lower-extremity amputation (NLEA) hospitalization rates, by diabetes status, among people aged 40 years and older on the basis of National Hospital Discharge Survey data on NLEA procedures and National Health Interview Survey data on diabetes prevalence.

The researchers found that the age-adjusted rate of diabetes-related lower-limb amputations was 3.9 per 1,000 people in 2008 compared with 11.2 per 1,000 in 1996. In addition, among people with diagnosed diabetes in 2008, men had higher age-adjusted rates of leg and foot amputations than women (6 per 1,000 vs 1.9), and blacks had higher rates than whites (4.9 per 1,000 vs 2.9). Adults aged 75 years and older had the highest rate—6.2 per 1,000—compared with other age groups.

"NLEA continues to be substantially higher" in people with diabetes than those without and "disproportionately affects people aged ≥75 years, blacks, and men," the authors write. "Continued efforts are needed to decrease the prevalence of NLEA risk factors and to improve foot care among certain subgroups within the US diabetic population that are at higher risk."